Field of the Invention
One aspect of the invention relates to predicting oocyte retrieval based on probabilities of oocyte numbers in poor prognosis patients with small oocyte yields and the administration of anti-Müllerian hormone (AMH) to such patients accordingly as warranted.
Discussion of Related Art
The small growing follicle pool between primary follicle and small preantral follicle represents the so-called functional ovarian reserve (FOR), which determined oocyte yields in association with in vitro fertilization (IVF). Women who have low FOR (LFOR) in general are poor prognosis patients in IVF, at least partially because they produce small oocyte yield and, therefore, also small embryo numbers (1).
Which LFOR patient could still be encouraged to use own eggs, and which should be directed toward donor eggs has remained controversial. We recently reported in this journal on live birth rates after IVF in very poor prognosis patients, and concluded that, especially in older women, the number of embryos available for transfer is a crucial determinant of outcome (2). Embryo numbers are, however, dependent on oocyte yields, and neither is currently predictable with reasonable accuracy in women with LFOR. The issue is further complicated by ooycte and embryo yields not only being FOR-dependent but also age dependent. A predictive model, therefore, has to consider FOR as well as female age.
At our center, approximately 30% of very poor prognosis patients do not reach embryo transfer (2). Among those, most are cancellations before retrieval and/or after unsuccessful retrievals in which no oocytes were obtained. While cycle costs in such cycles are relatively limited, it would, nevertheless, be desirable to be able to predict with reasonable accuracy probabilities of individual poor prognosis patients to produce oocytes. From the small numbers of likely oocytes in such patients, one then can further assess the likelihood of reaching embryo transfer.
Follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH) represent FOR, are related to oocyte yields but appear to represent distinctively different components of FOR (3).
The hitherto unanswered question, therefore, arises to what degree these two hormones in women with LFOR at different ages are predictive of small oocyte yields. We previously demonstrated that different combinations of FSH and AMH affect IVF outcomes (3). It, therefore, is likely that these two hormones at different ages may have varying significance in defining FOR and, therefore, oocyte yields.
In order to answer this question, this study assessed age-specific probabilities of retrieving ≥1 to ≥5 oocytes in women with LFOR at different ages based on their FSH and AMH levels.